Logo image
Back
Functional Assessment of FECD in the National Advanced Driving Simulator: Initial Study of Nighttime Glare and Scheimpflug Imaging
Journal article   Peer reviewed

Functional Assessment of FECD in the National Advanced Driving Simulator: Initial Study of Nighttime Glare and Scheimpflug Imaging

Simran R Sarin, Matthew Kigin, Evan Balk, Ryan Diel, Jennifer Ling, Mark A Greiner, Elliott H Sohn, Mark E Wilkinson, Timothy Brown and Christopher S Sales
Cornea, Vol.45(5), pp.595-601
05/2026
DOI: 10.1097/ICO.0000000000003894
PMID: 40407753

View Online

Abstract

The aim of this study was to quantify nighttime driving differences in patients with Fuchs endothelial corneal dystrophy (FECD) using the FDA-validated National Advanced Driving Simulator MiniSim. We conducted a pilot study to calculate sample size, followed by a prospective study with 6 patients with FECD and 6 controls. Participants underwent Snellen visual acuity (VA) testing, Mars contrast sensitivity (CS) assessment, and Scheimpflug tomography. Participants completed 3 simulated driving scenarios, identifying hazards while detection distances were tracked. Driving scenarios simulated glare conditions from oncoming headlights at night: "variable glare" modulated glare intensity with passing traffic, "constant glare" kept glare intensity fixed, and "no glare." The primary outcome was hazard recognition under "variable glare." Age, CS, and VA did not differ significantly between groups. Anterior and posterior densitometry were worse in the FECD group versus controls (anterior: 37.9 ± 6.0 vs. 28.9 ± 1.5, P = 0.01; posterior: 20.1 ± 3.1 vs. 16.5 ± 1.0, P = 0.02). Patients with FECD recognized 14% fewer hazards than controls (variable glare: 81.8 ± 12.1 vs. 95.8 ± 4.7%, P = 0.03). Patients with FECD required being nearly twice as close to hazards to recognize them versus controls (76.5 ± 38.8 vs. 137.7 ± 51.9 ft; P = 0.04). Tomographic markers of subclinical corneal edema (r = -0.61, P = 0.03) and higher anterior densitometry values (r = -0.61; P = 0.04) correlated with shorter hazard detection distance under "constant glare." Thicker central corneal thickness (variable glare: r = -0.60, P = 0.04) and higher posterior densitometry values correlated with lower hazard recognition scores (variable glare: r = -0.67, P = 0.02; constant glare: r = -0.65, P = 0.02). Despite normal VA and CS, patients with FECD performed significantly worse in driving simulations than controls. Driving disability was associated with tomographic measures of subclinical corneal edema and abnormal corneal densitometry.
 nighttime driving Fuchs endothelial corneal dystrophy disability glare driving simulator DMEK

Details

Metrics

13 Record Views
Logo image